Provider Demographics
NPI:1467452235
Name:BORGES, MICHAEL FREITAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREITAS
Last Name:BORGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:1801 E. MARCH LN.
Practice Address - Street 2:STE 360
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6675
Practice Address - Country:US
Practice Address - Phone:209-951-1178
Practice Address - Fax:916-733-6985
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72319174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467452235Medicaid
CA1467452235Medicaid
CAF80232Medicare UPIN
CAF80232Medicare UPIN
CA00G723191Medicare PIN